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FOR SERVICE CALL SERVICE ORDER 'DW NO AESW4 RPI:V )'C, <br /> DIXON OFFICE <br /> -800-7 ASBURY SERVICE ORDER NO. <br /> FRESNO = <br /> irk= <br /> 559-498-0240 <br /> 'HICOOFFIC <br /> d0-733-9043 H 1:7 <br /> 40 ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE, COMPTON. CA 90221 <br /> 1-310-88MAR 2 8 2016 <br /> 6.-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> P <br /> F-WHONMENTAL <br /> 11-A 1—1 <br /> MER PiJ, ORDER# ROUTTE—i "i RUCK CONTACT NAVE ORDER TAKEN SY <br /> 1DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# <br /> PART# DESCRIPTION CITY UNIT PRICE QTY P!U T07AL <br /> TOTAL <br /> -*H REC°D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED- STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> El <br /> SA RECYCLING 33210 Westeri 1 ,Aven tie, Un sori City, CA 04587 1-510-487..9277 <br /> DRUMS PIU: EMPTY'DRUMS: FACIUTY. BSC II <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> i J- s!-_.certify that the rvaata d", C,.becl t- C.Is p,.15"ly i.I 65tfied,described,packaged.marked and labeled.sial:s in proper condition for cf­sportatioo,&;ccwdrnU to appitcabie State <br /> and federal regulations.By signing below I also hereby cartiffy that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> O 01 t I have riot mixed any of the waste described above witi-,any other hazardous waste,the total halide content is LESS than 1,000 ppm.and the waste does not contain any PC85.I have <br /> complied with the requirements of the applicable California used oil management regulations to determine this Is;cue.I agree to accept the additional charges for the disposal of this waste <br /> it the information I have provided about this waste is incorrect <br /> CI 92)i have not mixed any of the waste described above with any other nazafdoos waste•the total halide content is GREATER than 1,000 ppm,and We waste do"not contain any PCOS.I <br /> have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was marid with other hazardous waste.t agree to accept the additional charges <br /> for the disposal of this waste it the intofmation I have provided about this waste is incorrect <br /> :]X31 Mrs waste.9 trorn a tank which co&$cts waste oil from household"do-it-yourself'(DIY)and/or corldrnorsally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DM CESQG collection tank is soley from DIY and/or CESOG sources I have not mixed this waste oil with any other hazardous waste or <br /> waste oil from other sources.I agree to accept the additional charges for disposal of this waste if the information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> U 04) if I am a large quantity generator,I rertify Chat I have a prrgirmirn In place to reduce the volume and toxicity of waste generated to the.degree I have determined to be economically <br /> ,,racticable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and <br /> environment;Or,If I am d small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available <br /> .ne that I can afford. <br /> Customer Signature Date' Driver Signature Date <br /> .......... <br /> Print Name Print Drivers Name <br />